At NorthBay Health The Medical Social worker develops, implements and monitors an individualized care plan in collaboration with the healthcare team. Provides direct clinical social work service, crisis intervention, brief counseling, discharge planning, and case management services to the patient and the family. Ensures patients are transitioned to optimal level of care as quickly as possible. Effectively communicates and collaborates with the patient, family, physician(s), nursing other healthcare team members, and community partners to coordinate post Emergency Department or inpatient care. Collaborates with community partners to optimize patient health. Communicates appropriate information to care providers in the continuum of care. Documents assessment and interventions in the patient’s medical record. Activities are consistent with System mission and values and in compliance with applicable regulations and System policies and procedures. The Medical Social Worker works under the direction of the Director/Manager of Social Services.